An Overview of Female Sexual Dysfunction

Psychological and Physiological Causes of Low Sex Drive

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Sexual health—and sexual function—depend on a variety of factors. What one person is satisfied with sexually, another finds deeply problematic. The amount of libido that a person has in one relationship may be quite different than the amount of libido they have in another relationship. The World Health Organization defines sexual health as "a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence." Sexual function is an important part of sexual health.

In order to understand the different types of female sexual dysfunction, it helps to understand the sexual response cycle. The most commonly recognized elements of the female sexual response cycle are:

  • Desire is the experience of being interested in having sex.
  • Excitement is when the body becomes physically aroused. There is an increase in blood flow to the genitals. The nipples and labia may engorge. There is some degree of lubrication. Sensitivity of the genitals increases.
  • Plateau occurs when the body is already excited, but a woman does not yet anticipate an orgasm.
  • Orgasm is a time of release. There may be contractions in the vagina or other feelings of dropping over a physical or emotional edge. Some women may experience multiple orgasms, going back and forth from orgasm to plateau.
  • Resolution is when the body returns to its usual, un-aroused state. Blood flow returns to normal. Many people feel very relaxed at this time.

Some people also include willingness in this model. Although people may feel like it's wrong to have sex if they're not turned on, sometimes being willing to engage sexually can lead to arousal.

Female sexual dysfunction can occur at any of the phases of the sexual response cycle. As many as half of all women experience difficulty with at least one aspect of sexual response.

Symptoms

The symptoms of female sexual dysfunction vary depending on which specific type of dysfunction a woman is experiencing.

Desire Phase Difficulties

There are several types of sexual dysfunction that can occur during the desire phase. The most common is decreased sexual desire or loss or sexual desire. This is when a woman has less (or no) interest in having sexual interactions. She may still be able to enjoy those interactions, but she is less likely to initiate sex. This is also referred to as hypoactive sexual desire disorder (HSDD).

Hypoactive sexual desire disorder is defined by the loss of spontaneous sexual desire, the inability to respond to sexual cues, and the inability to maintain interest during sex spanning the course of at least six months.

On the other hand, sexual aversion is when someone has strong negative feelings about having sex with their partner, this usually leads to avoiding sex.

Excitement or Arousal Phase Difficulties

Some women experience a lack of sexual enjoyment. They can experience arousal and even orgasm but do not find those sensations pleasurable. It is not always clear if this is an excitement or arousal phase disorder. Other women experience clearer disorders of arousal. They may not experience any, or sufficient, vaginal lubrication. Their genital skin may not engorge, and touch may be uncomfortable instead of pleasurable.

Orgasm Phase Difficulties

Some women find it difficult or impossible to reach orgasm. This may be referred to as anorgasmia. It may also take women an uncomfortably long time to reach orgasm.

Sexual Pain Disorders

Two types of sexual pain disorders are reported by women. The first, vaginismus, is an uncontrolled spasm of the muscles surrounding the vagina. It can make sexual penetration painful or even impossible. In contrast, dyspareunia is any pain experienced during sexual intercourse. Pain during sex may also have secondary effects of making women less interested in sex.

Causes

Female sexual dysfunction can have both physical and psychological causes. Indeed, some women who start out with organic, or medical, causes of sexual dysfunction can develop secondary dysfunction that is psychological. After all, if pain makes you afraid to have sex, it may be difficult to get rid of the fear, even once the pain is gone.

Psychological Causes of Female Sexual Dysfunction

While it is clear that a woman's psychological state can contribute to female sexual dysfunction, it is often a chicken-and-egg situation. Are the emotional stresses triggering the sexual problems or are the sexual problems causing stress, depression, or anxiety? The truth is, for many women, it may turn out to be a little of both.

Depression can lead to feelings of low self-esteem or dissatisfaction with one's body. This may make a woman feel less attractive and less interested in having sexual interactions with her partner. Her partner may find this frustrating, and that frustration could cause tension to build in the relationship. If the partner's reaction is bad enough, it could even lead to severe anxiety or sexual aversion.

It is possible for almost any type of female sexual dysfunction to have a psychological cause, or a cause that is at least partially psychological. Depression and anxiety can get in the way of arousal or orgasm. A history of sexual trauma or extreme anxiety may lead to vaginismus. Arousal problems caused by difficulty in a relationship could end up inadvertently causing sexual pain.

It's also worth noting that this association can go the other way as well. For many women, being sexual is an important part of their identity. Therefore, sexual problems can lead to a woman feeling less like herself. Some women who experience sexual dysfunction have described feelings of frustration, hopelessness, anger, poor self-esteem, and loss of femininity. Sexual dysfunction can also cause dissatisfaction with a woman's sex life, partner, or relationship

How can women tell if their sexual dysfunction is primarily psychological?

One sign is dysfunction that only occurs in certain circumstances or with specific partners. If your body responds just fine when you masturbate, problematic sexual interactions with a partner may be a reflection of stress in your relationship. If your sex life is fine on the weekends but not after a long day at work, your dysfunction may be the result of stress or exhaustion.

However, it's important to remember that just because the cause of female sexual dysfunction is primarily psychological doesn't make it any less real. It just means that the approach needed to treat it is primarily behavioral rather than medical.

Physiological Causes of Female Sexual Dysfunction

There are a number of medical conditions that can have a profound effect on women's sexual health. Conditions like thyroid disease and certain autoimmune disorders, for example, are closely linked to HSDD. In cases like these, any malfunction in hormonal/immune regulation can significantly affect the excitatory sexual systems of the brain. Moreover, the medications used to treat these disorders can interfere with the various neurotransmitters that modulate sexual desire. So can many of the medications used to treat other conditions such as depression and anxiety.

Aging and menopause can also substantially affect a woman's sexual function, particularly in the arousal phase. A lack of estrogen can cause issues with vaginal dryness and lack of lubrication. This can make sex less pleasurable or even painful, without the appropriate use of lubricants. (Local estrogen treatment can also help restore vibrancy to genital tissue.)

Conditions that affect the genital tissues can also cause sexual dysfunction. For example, certain sexually transmitted diseases can cause pain during sex. Other conditions such as ovarian cysts, endometriosis, and even cancers of the genital organs can also lead to sexual pain. It's also important to understand that your overall cardiovascular health can impact your sexual function. Any condition that affects blood flow has the potential to also impact sexual well-being

Diagnosis

Female sexual dysfunction is diagnosed in two stages. First, a doctor has to understand how sexual dysfunction is affecting your life. Then, the doctor has to try and figure out what's causing it.

Depending on the type of sexual dysfunction a woman is experiencing, she may see one or more different types of doctors. Arousal, excitement, or orgasmic disorders may first be recognized in the course of a primary care visit or even in a therapist's office. Sexual pain may first be revealed to a gynecologist during an annual exam.

In order to diagnose dysfunction, the first step is to take a sexual history. Your doctor will ask you what your sex life is like now and how it has changed over time. She may ask if you have ever experienced an orgasm and if sex is ever painful. Your doctor will also likely ask if your sexual symptoms occur when you masturbate or only when you have sex with a partner, or with a specific partner.

Usually, doctors will try to rule out organic causes of sexual dysfunction first. This may include blood work to check your overall health. It may also include a pelvic exam to check for any changes that could be caused by endometriosis, lichen sclerosis, or other local conditions. It will probably also include STD testing. Even if you've been in a monogamous relationship, it's possible to have undiagnosed and/or unrecognized STDs. Finally, your doctor may review your medications to see if any of them can cause sexual side effects.

If there are no clear physical causes of your sexual dysfunction, you may be referred to a therapist or sex therapist. The therapist will screen you for conditions including depression, anxiety, and PTSD as well as help you see if problems in your relationship may be causing problems with your sexual health.

Treatment

Treatment for female sexual dysfunction depends on its cause. For example, a woman may be prescribed hormone replacement therapy if her arousal issues are caused by menopause. Her medications may be changed if antidepressants or another drug are reducing her interest in sex. She may be put on medication to lower her blood pressure or help her cholesterol if heart health is causing problems in the bedroom.

When psychological causes are involved, a woman will likely be referred to either individual or couples therapy. Ideally, she would be referred to a sex therapist who focuses on helping individuals and couples improve their sexual interactions. However, for some women, it's more important to focus on the relationship and other stressors before starting to work on sex.

Coping

One of the hardest thing about coping with female sexual dysfunction is how it can turn into a vicious cycle. Problems with a relationship lead to problems with sex, which cause bigger problems with the relationship. It can be hard to figure out how to start anew. One technique commonly used by sex therapists is to take sex off the table for a while. Thinking about when and if you're going to try to have sex with your partner can cause a lot of anxiety all the time. Taking a break from sex for a specified period of time can help you find ways to enjoy each other again without worrying about what that enjoyment will lead to. (And sometimes being told that you can't have sex with each other is the very thing that makes you want to do so more.)

A Word From Verywell

It can be hard to admit to yourself, let alone your doctor, that you're having problems with sex. However, being brave can make a big difference in your life. Female sexual function is often quite treatable. But you can't get help unless you can first admit that you need it.

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